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Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis

Gillett, M., Dallosso, H., Dixon, S., Brennan, A., Carey, M. E., Campbell, M. J., Heller, S., Khunti, K., Skinner, Timothy C. and Davies, M. J. (2010). Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis. BMJ: British Medical Journal,341(c4093):1-10.

Document type: Journal Article
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IRMA ID 82794376xPUB145
Title Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis
Author Gillett, M.
Dallosso, H.
Dixon, S.
Brennan, A.
Carey, M. E.
Campbell, M. J.
Heller, S.
Khunti, K.
Skinner, Timothy C.
Davies, M. J.
Journal Name BMJ: British Medical Journal
Publication Date 2010
Volume Number 341
Issue Number c4093
ISSN 0959-535X   (check CDU catalogue  open catalogue search in new window)
eISSN 1756-1833
Scopus ID 2-s2.0-84859005073
Start Page 1
End Page 10
Total Pages 10
Place of Publication United Kingdom
Publisher British Medical Journal Publishing Group (BMJ Publishing)
HERDC Category C1 - Journal Article (DIISR)
Abstract Objectives
To assess the long term clinical and cost effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) intervention compared with usual care in people with newly diagnosed type 2 diabetes.

Design

We undertook a cost-utility analysis that used data from a 12 month, multicentre, cluster randomised controlled trial and, using the Sheffield type 2 diabetes model, modelled long term outcomes in terms of use of therapies, incidence of complications, mortality, and associated effect on costs and health related quality of life. A further cost-utility analysis was also conducted using current “real world” costs of delivering the intervention estimated for a hypothetical primary care trust.

Setting
Primary care trusts in the United Kingdom.

Participants

Patients with newly diagnosed type 2 diabetes.

Intervention

A six hour structured group education programme delivered in the community by two professional healthcare educators.

Main outcome measures

Incremental costs and quality adjusted life years (QALYs) gained.

Results

On the basis of the data in the trial, the estimated mean incremental lifetime cost per person receiving the DESMOND intervention is £209 (95% confidence interval −£704 to £1137; €251, −€844 to €1363; $326, −$1098 to $1773), the incremental gain in QALYs per person is 0.0392 (−0.0813 to 0.1786), and the mean incremental cost per QALY is £5387. Using “real world” intervention costs, the lifetime incremental cost of the DESMOND intervention is £82 (−£831 to £1010) and the mean incremental cost per QALY gained is £2092. A probabilistic sensitivity analysis indicated that the likelihood that the DESMOND programme is cost effective at a threshold of £20 000 per QALY is 66% using trial based intervention costs and 70% using “real world” costs. Results from a one way sensitivity analysis suggest that the DESMOND intervention is cost effective even under more modest assumptions that include the effects of the intervention being lost after one year.

Conclusion
Our results suggest that the DESMOND intervention is likely to be cost effective compared with usual care, especially with respect to the real world cost of the intervention to primary care trusts, with reductions in weight and smoking being the main benefits delivered.
DOI http://dx.doi.org/10.1136/bmj.c4093   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 2.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 2.0 License
URL https://creativecommons.org/licenses/by/2.0/


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